CPT 99213: Established Patient Office Visit, Low Complexity
CPT 99213 reports an established patient office or outpatient visit with low medical decision making or 20-29 minutes of total time. It is a core primary-care follow-up code. In 2026 Medicare pays about $95.19 non-facility (2.85 total RVUs times the $33.4009 conversion factor) and about $57.45 in a facility.
- Code type
- Established patient E/M (office/outpatient)
- 2026 non-facility
- $95.19 (2.85 RVUs)
- 2026 facility
- $57.45 (1.72 RVUs)
- Time (if used)
- 20-29 minutes total on the date
What is CPT 99213 used for?
CPT 99213 is an office or outpatient visit for an established patient requiring low medical decision making or 20-29 minutes of total time. Alongside 99214, it is the backbone of outpatient follow-up billing: stable chronic-disease checks, routine medication follow-ups, and minor acute complaints. Since 2021, level selection is by MDM or total time; history and exam must be appropriate but do not set the level.
Low MDM typically means one stable chronic illness, two or more self-limited or minor problems, or one acute uncomplicated illness, usually with limited data such as reviewing a lab or ordering a test, and low risk. An established patient is one seen by you or a same-specialty and subspecialty physician in your group within the prior three years.
How much does 99213 pay in 2026?
99213 carries 2.85 non-facility RVUs and 1.72 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 2.85 | ~$95.19 |
| Facility | 1.72 | ~$57.45 |
Medicare pays 80 percent of the allowed amount after the deductible; the patient or secondary owes the 20 percent coinsurance. See your locality-adjusted rate on the Medicare fee calculator.
How is 99213 different from 99214?
This is the highest-stakes leveling decision in primary care because the two codes carry most of the volume. The dollar gap is about $40 per visit, so systematic downcoding to 99213 out of audit fear is a large, silent revenue leak, while reflexively coding 99214 invites the opposite scrutiny.
Example: an established hypertensive patient, stable on one medication, seen for a 22-minute recheck with no dose change, is a clean 99213 (~$95.19). Change the facts, blood pressure now uncontrolled, medication adjusted, and the same encounter becomes 99214 (~$135.61).
Frequently asked questions
By time, 99213 requires 20-29 minutes of total time the physician or QHP spends on the patient on the date of service, including chart review, the visit itself, and same-day documentation and orders. If you code by MDM instead, low complexity controls and time is not required.
The 2026 national non-facility allowed amount is about $95.19 (2.85 total RVUs times $33.4009). In a facility it is about $57.45 (1.72 RVUs). Medicare pays 80 percent after the deductible; the patient or secondary owes the 20 percent coinsurance.
Use 99213 when the visit is low complexity: one stable chronic illness, two minor problems, or one acute uncomplicated illness with limited data and low risk. Step up to 99214 when there is an exacerbation, prescription drug management, an undiagnosed problem, or two-plus chronic conditions being actively managed. The pivot is problem severity and risk, not note length.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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